Symptomatic Coronary Anomalies and Ischemia in Teenagers - Rare but Real
Julia Borns1, Christoph Gräni2, Alexander Kadner3
1Department of Cardiology, Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
Anomalous aortic origin of the coronary arteries (AAOCA) in teenagers can cause exercise-induced symptoms. Early diagnosis and surgical correction, like unroofing, lead to favorable outcomes for this rare but potentially life-threatening condition.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Anomalous aortic origin of the coronary arteries (AAOCA) is a rare congenital heart defect.
- It can lead to significant morbidity and mortality, particularly in young individuals.
- Symptoms often manifest during physical exertion, mimicking other common conditions.
Observation:
- This report details three adolescent cases presenting with exercise-induced chest pain, syncope, and dizziness.
- Multimodal imaging was crucial in diagnosing the anomalous coronary artery course (interarterial/intramural).
- These anatomical variations explained the observed exercise-induced ischemia.
Findings:
- All three patients underwent successful surgical correction via unroofing of the anomalous coronary artery.
- Post-operative outcomes were favorable, with symptom resolution.
- The study highlights the importance of recognizing AAOCA in symptomatic adolescents.
Implications:
- Physicians must maintain a high index of suspicion for AAOCA in teenagers with exertional symptoms.
- Accurate diagnosis through advanced imaging is critical for timely intervention.
- Prompt surgical management of AAOCA can prevent severe complications and improve long-term prognosis.
Abstract:
Three cases of teenagers with anomalous aortic origin of the coronary arteries (AAOCA) are presented with typical exercise induced symptoms (chest pain, syncope or dizziness). Using multimodal imaging, diagnoses was confirmed showing interarterial and/or intramural course of the coronary artery explaining the ischemia induced symptoms. Successful surgical correction with unroofing of the AAOCA was performed in all three cases with a favorable outcome. Even though AAOCA are rare, some variants may be relevant and potentially life threatening, therefore treating physicians should be aware of correctly diagnosing and treating these individuals.
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